Washington, DC (November 15, 2023) – The American Academy of Nursing (Academy) amplifies its call for humanitarian aid in all parts of the world where armed conflict, terrorism, and violence have devastated communities, razed support networks, and most horrifically, caused injury and loss of life.^1,2 Adherence to international humanitarian law requires civilians not be a target of military advances – specifically outlined in the Geneva Convention IV³ (GCIV) relative to the Protection of Civilian Persons in Time of War. Additionally, the Geneva Convention I⁴ requires humane treatment for all persons in enemy hands, specifically prohibiting murder, mutilation, torture, the taking of hostages, unfair trial, as well as cruel, humiliating, and degrading treatment. Moreover, health care workers and health care settings, as well as the transportation and delivery of health care supplies, must be protected at all times during any acts of violence and armed conflicts, as outlined in GCIV.

Living through armed conflict and in areas experiencing humanitarian crisis impacts all aspects of the human condition. The devastation interrupts access to basic needs like food, water, shelter, and communication and negatively impacts physical, mental, and emotional health. In times of conflict, resources must be able to reach the people and communities impacted by violence. Safe passage for civilians to evacuate armed conflict-torn areas as well as access to medical convoys providing aid to those impacted is paramount. The Israel-Hamas war is magnifying the dire need for immediate intervention to provide humanitarian aid as the civilian loss of life increases each day. The Academy calls on Congress and the Biden Administration to work in a bipartisan manner to urgently approve funding for humanitarian aid in order to protect all civilians impacted on both sides of the conflict. This will allow health care workers, striving to provide care in extreme circumstances, to reduce loss of life amid the conflict. We encourage the inclusion of health care professionals with advanced expertise, such as nurses with disaster training, in the policy deliberations as they can delienate the necessary specificities that need to be taken into account when providing humanitarian assistance in zones of crises, such as war. 

The Academy stands with its nursing and health care colleagues risking their lives in the face of danger, violence, and armed conflict. Moral distress in times of crisis⁵ deteriorates nurses’ resiliency and mental health support must be provided to health care workers. This support needs to extend beyond the end of their time in the conflict zone as moral distress can manifest much later on. Moreover, caring for severe polytrauma casualties cases, and particularly children who are injured or dying, creates dire psychological stress on clinicians.⁶ The trauma that nurses serving in the military and the health care workforce face when actively supporting communities in conflict zones must be addressed beyond their service to ensure they are able to continue their life saving efforts. When there is not relief for health care providers through rapid humanitarian aid in the form of medical supplies, essential care providers, and other assistance such as access to electricity and water, nurses and clinicians can experience secondary traumatic stress and physical exhaustion, increasing community-level risk of being placed in a further state of crisis. 

Terrorism and violence must always be condemned; we must stand together against all forms of hatred and brutality. Attacks on human rights hinder the Academy’s vision of healthy lives for all people. The Academy urges swift action to improve the health and care for victims, displaced persons, refugees, and clinicians exposed to trauma and violence from armed conflicts.

The Academy’s Expert Panels on Global Nursing and Health, Trauma & Violence, Military & Veterans Health, and Bioethics contributed to the development of this statement.